| NPI | 1861753485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME130378) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301100883) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301100883) | |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2018-06-01 |